Pregnancy riskier for rural women without health insurance

Illustration by Alexis Jang, The New York Times

The physical demands of pregnancy are risky, and "Women and birthing people in rural America are at higher risk of adverse maternal-health outcomes, including maternal morbidity and mortality . . . One possible factor: lower enrollment in health insurance," the University Michigan reports on a study by researchers there. "Residents of rural communities had lower rates of continuous health insurance before, during and after pregnancy compared to those in urban cities."

Lead author Dr. Lindsay Admon said in the news release, "Being uninsured during the time of pregnancy has been associated with less adequate prenatal and postpartum care, which decreases opportunities to address risk factors affecting health outcomes for both the birthing person and baby. . . . Our study suggests that uninsurance disproportionately affects rural residents during pivotal stages of pregnancy."

To flesh out disparities, "Researchers analyzed survey data from 154,992 post-partum individuals in 43 states in 2016-19, including roughly 16 %, or 32,178, rural residents," the release says. "They compared rates of those without any insurance or had gaps in coverage between rural and urban residents during preconception, at the time of birth, and postpartum."

Admon noted, “Rural inequities persisted regardless of age, marital status or insurance type. But these differences were even more significant among specific racial and ethnic groups." The release says: "In each of the three periods, rural residents who were non-Hispanic white, married, and with intended pregnancies experienced greater odds of less adequate or consistent insurance compared to their urban counterparts. They were also less likely to have commercial health insurance during any of those times."

Insurance that extends past 60 days after birth also needs review, the release says: "This lack of coverage the year after pregnancy is especially worrisome, Admon says, since rural residents without postpartum insurance in the study were more likely to be older than 35 and have obesity or chronic hypertension compared with uninsured urban residents." Admon added, "We need to explore policies that help increase insurance enrollment during all phases of pregnancy and that account for rural differences . . . Health insurance is critical to accessing quality healthcare and improving maternal health in the U.S. We hope these findings help inform policies that address rural–urban inequities in maternity care access and maternal health across the country."